Risk Adjustment Coding Analyst

Location: Tigard, OR, United States
Position Purpose: Audit vendor and internal risk adjustments coding to ensure accuracy and identify and mitigate any risks.
  • Validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records
  • Review and identify trends in coding discrepancies and notify applicable department for potential training and education
  • Determine coding issues and discrepancies and make updates as necessary
  • Identify issues, determine impact to risk adjustment models and reports results for various products and services
  • Coordinate delete files with leadership from Medicaid, Medicare, and Marketplace and Encounters department

Qualifications:
Education/Experience:
  • High school diploma or equivalent
  • 2+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry OR Associate’s degree in health related field and 1+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry. Experience with various risk adjustment methodology and chart audits. 
  • Must be knowledgeable in Microsoft Excel, Word and Outlook.
  • Have critical thinking skills.  Be willing to take a Risk Adjustment Coding Pre-Test before final selection is made.

Licenses/Certifications: CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA or CPMA required.
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 

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www.linkedin.com/in/aprilaestes
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